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1. Raymen Rammy Assaf, MD, MPH, MIA* 2. Maria Levine, MD† 3. Clement Cheung, MD, PhD‡ 4. Benita Tamrazi, MD§ 5. Jennifer A. Cotter, MD¶,** 6. Michael Bryant, MD, MBA†† 7. Erin N. Kiehna, MD‡‡ 1. *Department of Pediatrics, 2. †Division of Psychiatry, Department of Pediatrics, 3. ‡Division of Endocrinology, Department of Pediatrics, 4. ¶Department of Pathology and Laboratory Medicine, and 5. ††Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA 6. §Department of Radiology, 7. **Department of Pathology, and 8. ‡‡Division of Neurosurgery, Department of Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA On June 3, 2017, 27-year-old Alex Honnold climbed the 2,900-foot rock face of El Capitan in Yosemite National Park, alone and with neither rope nor safety net. The story is shown in the 2018 documentary film Free Solo and described in the 2018 book The Impossible Climb by Mark Synnott. Many reading this issue of Pediatrics in Review have moved to new levels of responsibility this summer and might feel like they are free-soloing too. Honnold did not do his free-solo climb on a whim. He prepared meticulously. He worked with colleagues and practiced moves for years, with ropes, on the same route that he would one day conquer on his own, unsupported. Just as with pediatric training, expertise comes with training, time, and practice. But, what did Honnold do during the afternoon of June 3, 2017, following what the New York Times called “one of the great athletic feats of any kind, ever”? He worked out to strengthen his grip for future climbs. In the same way, we who care for children keep working out. We keep honing our skills. We meticulously study possible “routes” as we consider cases and differential diagnoses and management plans. After each patient care success, we keep “working out” for the next challenge. Even so, may you use this month’s Index of Suspicion cases to “strengthen your grip” so you can be effectively prepared to work through steep diagnostic challenges as you reach new heights of pediatric practice. Philip R. Fischer, MD Associate Editor, Index of Suspicion An 11-year-old girl with a 2-year history of major depressive disorder presents …